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Creatine kinase, troponin elevation linked with mortality in CABG patients
Domanski M. JAMA. 2011;305:585-591.
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Elevation of creatine kinase and troponin levels within 24 hours of CABG was independently associated with increased intermediate- and long-term mortality risk, according to results of a meta-analysis.
The analysis, published in the Journal of the American Medical Association, included data from seven studies and included a total of 18,908 patients. Each of the studies analyzed the association between mortality and creatine kinase (CK-MB) or troponin or both. All data included the measurement of cardiac markers within 24 hours of CABG.
During a follow-up ranging from 3 months to 5 years, researchers reported that, after using a log-linear logistic model, increases of CK-MB ratio value of 4.4 led to an expected 30-day mortality more than double that for a CK-MB ratio of 1. This association persisted, even after adjustment for multiple variables. Further, although the association at 30 days was the strongest, it persisted from 30 days to 1 year, as well as from 1 year to 5 years.
Similar analyses using troponin as the necrosis marker produced the same outcome.
“(These findings) may inform the design of future clinical trials with respect to using cardiac markers as an outcome measure following CABG surgery,” the researchers wrote. “Although these findings require confirmation in large prospective studies, they suggest that there are clinical implications in terms of long-term prognosis for cardiac enzyme elevations following CABG surgery, particularly among those with very high levels.”
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